以广西某三甲医院的实证为例分析DRG支付改革对鼻咽癌患者住院费用的影响OA

Objective To analyze the impact of the implementation of DRG payment reform on hospitalization costs and their structure for patients with nasopharyngeal carcinoma,to evaluate the effectiveness of this medical insurance payment reform in addressing regional malignant chronic diseases,and to provide a reference for improving healthcare policy and hospital medical insurance management decision-making.Methods The front-page data of medical records from 4,024 patients with nasopharyngeal carcinoma who were discharged from a tertiary hospital in Guangxi from 2019 to 2023 were selected as sample data.The hospitalization costs,expenses for medical services and therapeutic services,diagnostic services,pharmaceuticals,and consumables,as well as radiotherapy status,chemotherapy status,and readmission after discharge status before and after the implementation of DRG payment reform,were analyzed.Results There were significant differences in radiotherapy status,chemotherapy status and readmission after discharge status between the two groups before and after the implementation of the DRG payment reform(P＜0.05);however,there were no statistically significant differences between the gender and age groups(P＞0.05).After the implementation of the DRG payment reform,hospitalization costs for patients with nasopharyngeal carcinoma showed a significant downward trend,and the cost structure was optimized,with a decrease in the proportion of pharmaceutical and consumable costs and an increase in the proportion of medical services and therapeutic services,which reflect the value of medical professionals'work.Conclusion DRG payment reform exerts a certain controlling effect on hospitalization costs for patients with nasopharyngeal carcinoma,though its constraining force is relatively weak,and its optimizing effect on the hospitalization cost structure has shown a weakening trend year by year.The medical insurance administration and hospitals should collaborate to establish a long-term mechanism for payment reform,transform management concepts,strengthen the construction of medical insurance information systems,and further establish an interdisciplinary administrative MDT model within hospitals to break down the silos among functional departments,enhance the management efficiency of medical institutions,and ultimately better serve patients.